Psychiatrists say diagnosis manual needs overhaul

A patient looks through a window inside a psychiatric hospital in Lima, Peru July 22, 2011. REUTERS/Enrique Castro-Mendivil

LONDON (Reuters) - Many psychiatrists believe a new edition of a manual designed to help diagnose mental illness should be shelved for at least a year for further revisions, despite some modifications which eliminated two controversial diagnoses.

The new edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM 5), a draft of which is open for public consultation this month, will be the first full revision since 1994 of the renowned handbook, which determines how to interpret symptoms in order to diagnose mental illnesses.

But more than 13,000 health professionals from around the world have already signed an open letter petition (at dsm5-reform.com) calling for DSM 5 to be halted and re-thought.

“Fundamentally, it remains a bad system,” said Peter Kinderman, a professor of clinical psychology at Britain’s Liverpool University.

“The very minor revisions...do not constitute the wholesale revision that is called for,” he said in an emailed comment.

The American Psychiatric Association (APA), which produces the manual and plans to publish DSM 5 next May, said on Wednesday it had decided to drop two proposed diagnoses, for “attenuated psychosis syndrome” and “mixed anxiety depressive disorder”.

The former, intended to help identify people at risk of full-blown psychosis, and the latter, which suggested a blend of anxiety and depression, had been criticized as too ill-defined.

With these and other new diagnoses such as “oppositional defiant disorder” and “apathy syndrome”, experts said the draft DSM 5 could define as mentally ill millions of healthy people - ranging from shy or defiant children to grieving relatives, to people with harmless fetishes.

“SIMPLY NOT USABLE”

Robin Murray, a professor of psychiatric research at the Institute of Psychiatry at Kings College London, said it was a great relief to see the changes in the draft, particularly to the attenuated psychosis diagnosis.

“It would have done a lot of harm by diverting doctors into thinking about imagined risk of psychosis (and) it would have led to unnecessary fears among patients that they were about to go mad,” he said in a statement.

But Allen Frances, emeritus professor at Duke University in the United States, said it was “only a first small step toward desperately needed DSM 5 reform”.

”Numerous dangerous suggestions remain, Frances, who chaired a committee overseeing the DSM 4, said, adding that DSM 5 “is simply not usable” and should be delayed for an extra year “to allow for independent review, to clean up its obscure writing, and for retesting”.

Diagnosis is always controversial in psychiatry, since it defines how patients will be treated based on a cluster of symptoms, many of which occur in several different types of mental illness.

Peter Jones, a professor of psychiatry at Cambridge University, said DSM 5 should be “underpinned by science” built on an understanding of the biology and functions of the brain and mind - something he said neuroscience was not yet able to do comprehensively enough.

“On this basis DSM 5 is, at best, premature and a waste of time,” he said.

Some argue that the whole approach needs to be changed to pay more attention to individual circumstances rather than slotting them into predefined categories.

Lucy Johnstone, a consultant clinical psychologist for the Cwm Taf Health Board in Wales agreed: “(The DSM)is wrong in principle, based as it is on redefining a whole range of understandable reactions to life circumstances as ‘illnesses’, which then become a target for toxic medications heavily promoted by the pharmaceutical industry,” she said.

“The DSM project cannot be justified, in principle or in practice. It must be abandoned so that we can find more humane and effective ways of responding to mental distress.”

One of the proposed changes that has survived in the draft DSM 5 - despite fierce public outcry - is in autism. The new edition eliminates the milder diagnosis of Asperger syndrome in favor of the umbrella diagnosis of autism spectrum disorder.